Bolus Lukewarm Saline With Sequential Posture Change: A New Mechanism of Gastrointestinal Lavage

Abstract

Introduction: Gastrointestinal Lavage (GIL) is necessary to clean the colon before a colonoscopy procedure. GIL can be done using laxatives classified as - 1) Osmotic (holding water inside the bowel lumen) -2) Stimulant (inhibition of water absorption or stimulation of secretion and colonic motility -3) Balanced electrolyte solutions administered in a volume of 2-4 L. We propose to introduce a new mechanism of GIL using Bolus Lukewarm Saline (BLS) with Sequential Posture Change (SPC). This method is inspired by an ancient yogic process - Shankh prakshalana that uses lukewarm saline water and a series of five simple asana, or postures, to clean the intestinal tract. Methods: This method involves drinking of BLS which is prepared by mixing 9gm of salt to 32 oz of lukewarm tap water. The solution is then consumed as a bolus (16oz) combined with SPC. The efficacy has been proved by our pilot study and randomized study. To implore the mechanism of action of this process - we have published a gastric emptying(GE) study and a perfusion study. Results: NA Conclusion: The gastric emptying of lukewarm saline follows the ‘First order kinetics' - 50 % of the volume empties out in 8-18 minutes. A larger volume of intake leads to faster GE, stimulating a strong gastro-colic reflex. The SPC further complements faster GE which can be labeled as ‘specific' to enhance GE for several reasons. Arm elevation in normal subjects increases end-inspiratory gastric and trans-diaphragmatic pressure. All postures are associated with auditory-vestibular stimulation, which is known to affect GE. The SPC used in this study are mild to moderate intensity exercises (MET: 3-5) which also enhances GE as opposed to strenuous exercises which is known to delay GE. The SPC Inputs from sensory sources are modified by cognition and effect, and then integrated in the central nervous system (CNS), autonomic nervous system (ANS) and enteric nervous system (ENS) with an outcome of effects on gastro-intestinal (GI) motility, secretion and blood flow. Deep breathing stimulates the parasympathetic nervous system via the vagus nerve, which is also known to increase the gastrointestinal motility. A Multi-Centered Randomized Study has been planned and designed to assess the safety and efficacy of this novel approach.